Beruflich Dokumente
Kultur Dokumente
DOI: http://dx.doi.org/10.5007/1980-0037.2014v16n4p475
original article
Abstract The aim of this study was to compare the values obtained through methods
directed to height and body weight estimates in relation to measurements taken from
hospitalized adult. Study participants were 142 adults of both genders. Anthropometric
measurements of body weight, height, knee height, arm length, span, demi-span, recum-
bent height, calf, arm and abdominal circumferences and subscapular skinfold thickness
were taken. The actual measurements were compared with those obtained from formulas
for estimating weight and height, using the paired t test. The estimated measurements dif-
fered significantly (p <0.001) from the actual measurements in both genders, observing
the tendency of overestimating these measurements. The exception was the estimated
height for men by the formula that utilizes the variable knee height (p> 0.001). The aver-
age estimated body weight closest to the actual body weight for men was obtained with
the formula that used the measurements of arm, abdominal and calf circumferences. For
women, the biggest coincidences were obtained by means of the formula that utilizes the
variable knee height. For both men and women, the averages related to the body mass
index, calculated through estimated body weight and height measurements resulted in
the same nutritional diagnosis when compared to the body mass index involving actual
measurements. The estimated height by the formula that utilizes the variable knee height
among men was the only measurement which did not represent significant differences.
Other methodologies for estimating body weight and height presented significant differ-
ences, which suggests that new studies using other methodologies are necessary.
Key words: Anthropometry; Body composition; Body weights and measures; Estimation
techniques.
INTRODUCTION
Nutritional assessment is a useful tool to support the therapeutic proposal
and monitor the effectiveness of nutritional interventions, especially in
hospitalized individuals1. Among the nutritional assessment methods,
anthropometric measurements stand out, in which body weight and height
are the most widely used. Both measures are essential for establishing the
nutritional diagnosis and dietary and pharmacological prescriptions2.
Subject who are bedridden and unable to walk require equipment
and technological solutions to meet the need for weighing in bed. Scales
integrated to hospital beds are examples, however, they have high costs
and are not reality in hospitals3.
Thus, many researchers have sought to develop methods to estimate
body weight and height from specific measures of body segments that can
be measured in these patients such as knee height, arm and calf circum-
ferences, skinfold thickness, among others4-10.
Considering the importance of measures such as body weight and
height as essential indicators in the assessment of the nutritional status and
the impossibility to take these measures in bedridden subjects, this study
aimed to compare values f ound by methods aimed to estimate body weight
and height most frequently used in clinical practice with measurements
taken in hospitalized adults.
METHODS
This is an analytical, quantitative cross-sectional study conducted in a pub-
lic hospital in southern Brazil from July 2011 to August 2012. The sample
was obtained by convenience and selected according to the following crite-
ria: adults aged 20-60 years of both sexes, able to walk and hospitalized in
medical and surgical clinics in the aforementioned hospital. Subjects with
peripheral edema, ascites or anasarca, with limb amputation or paralysis
or on dialysis were excluded.
The project was approved by the Ethics Committee on Human Research
of the Federal University of Santa Catarina, Protocol 1107. All study par-
ticipants signed the informed consent form.
Anthropometric measurements were selected according to variables
contained in the formulas for estimating body weight and height selected
in this study (Box 1). The final data collection was preceded by training
of the researchers involved, seeking to standardize procedures and mea-
surement techniques.
Measurements were taken in the morning after a fasting period of
10 hours and after urination. Anthropometric measurements taken were
height, body weight, semi-span (SS), span (S), recumbent height (RH),
knee height (KH), arm length (AL), arm circumference (AC), calf circum-
ference (CC), abdominal circumference (AC) and subscapular skinfold
thickness (SEsf).
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Box 1. Formulas analyzed in the present study.
Rabito et al.2 (A3 e A4) Height = 58.6940 (2.9740 x sex*) (0.0736 x age) + (0.4958 x arm length)
+ (1.1320 x semi-span)
Height = 63.525 (3.237 x sex*) (0.06904 x age) + (1.293 x semi-span)
Chumlea et al.4 (A6) White women: Height = 70.25 + (1.87 x knee height) (0.06 x age)
Black women: Height = 68.1+ (1.86 x knee height) (0.06 x age)
White men: Height = 71.85 + (1.88 x knee height)
Black men: Height = 73.42+ (1.79 x knee height)
Cereda et al.8 (A7) Height = 60.76 + (2.16 knee height) (0.06 x age) + (2.76 x sex**)
shoulders12.
RH measurement involved the individuals length obtained with a flex-
ible, inelastic measure tape after marking the stretcher with chalk through
the triangle from top of the head to the foot sole with patient in the supine
position and with bed in complete horizontal position13.
KH was measured with subject in the supine position with the right leg
at an angle of ninety degrees with knee and ankle using Cescorf caliper,
comprising a fixed part, which was positioned in the plantar surface of the
foot (heel) and a movable part pressed on the head of the patella (kneecap)6.
AL was measured in the right arm with forearm flexed at ninety de-
grees, and measure was taken from the tip of the acromion process of the
scapula and the olecranon process of the ulna, with measure tape on the
lateral side of the arm14.
Circumferences were measured with a flexible and inelastic measure
tape on the right side of the body according to techniques proposed by
Callaway et al.15. AC was measured at the midpoint between the acromion
and the olecranon; CC in the maximum circumference of the calf muscle of
the right leg and AC was assessed on the smallest horizontal circumference
in the area between the ribs and the iliac crest.
SEsf was obtained by averaging three measurements with Lange
compass obliquely to the longitudinal axis. The caliper jaws applied 1 cm
infero-lateral to the thumb and finger raising the fold, and the thickness is
recorded to the rearest 0,1 cm. The orientation of the costal arches located
one centimeter below the inferior angle of the right scapula16.
Nutritional status was evaluated through the body mass index (BMI),
calculated using the Body Weight (kg) / height (m) coefficient. Nutritional
status was classified according to cutoffs recommended by the World Health
Organization (WHO)17. Forty-seven BMI combinations were calculated
using estimated measures. We chose to examine only those with more
satisfactory results.
Data were analyzed using the STATISTICA software, version 7.0. All
variables were tested for normality by the Kolmogorov-Smirnov test. As-
suming that all variables considered were normally distributed, the paired t
test was used. As level of statistical significance, p value 0.05 was adopted.
RESULTS
The study included 142 adults, 74 (52.1%) were male. The average age of the
sample was 42.5 years 11.1 years. Regarding nutritional status, overweight
was identified in 29% of women and 28% of men.
Tables 1 and 2 show statistical information regarding actual and
estimated height and body weight measures according to the different
methods adopted.
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Table 1. Comparison between actual and estimated height measures (m) of hospitalized adults
SD = Standard deviation; A1 = Mitchell & Lipschitz4; A2 = WHO5; A3 e A4 = Rabito et al.2; A5 = Gray et al.13; A6 =
Chumlea et al. 7; A7 = Cereda et al.8.
With respect to height, it was found that the estimated measures dif-
fered significantly (p <0.001) from actual measures for men and women.
The exception was height estimated by the formula of Chumlea et al.7 (A6)
for men, which showed no significant mean difference (p> 0.05) compared
to the actual measure. This formula was also the only one who underesti-
mated actual height for females. Formulas developed by Rabito et al.2 (A3
and A4) showed the closest measures of actual height for females.
The formula that showed the largest average difference from the actual
height for both sexes was the formula that used the semi-span measure
(A1)4, overestimating the height by 9 cm for males and 6 cm for females.
The formula of WHO (A2)17, which uses the wingspan measure, also showed
significant difference from the actual measure, but with lower mean dif-
ferences (3 cm for males and 5 cm for females).
Mean differences between actual and estimated measures were sig-
nificant (p<0.001), with overestimation of the actual body weight in all
formulas of estimated weight for both sexes, with the exception of body
weight obtained by the formula of Chumlea et al.6 (P1), which underes-
timated body weight in women. Estimated body weight measures closest
to the actual weight for men were obtained with the formulas of Rabito et
al.2 (P2 and P3) and for women with the formula of Chumlea et al.6 (P1).
Greater differences were obtained by using the formula of Ross Laborato-
ries9 (P5), which overestimated the actual body weight by 4.5 kg for males
(-9.42, 18.48 kg) and 3.3 kg for females.
Table 2. Comparison between actual and estimated body weight measures (kg) of hospitalized adults
SD = standard deviation; CI = confidence interval; P1 = Chumlea et al.7; P2, P3 and P4 = Rabito et al.2; P5 = Ross
Laboratories9.
The averages of estimated BMI (24.68 kg/m for males and 27.71 kg / m
for female) resulted in the same nutritional diagnosis of actual BMI: nor-
mal weight among males and overweight among females (Tables 3 and 4) .
Table 3. Comparison between actual and estimated body mass index values (kg / m) of hospitalized male adults
p
Variables Mean SD Dif Mean t
SD = standard deviation; Actual BMI = actual weight / (actual height) ; BMI1 = actual weight /(A6); BMI2 =
actual weight /(A4); BMI3 = P2/(actual height); BMI4 = P2/(A6); BMI5 = P2/(A4); BMI6 = P3/(actual height);
BMI7 = P3/(A6); BMI8 = P3/(A4); A4, P2 and P3 = Rabito et al.2; A6 = Chumlea et al.7).
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Table 4. Comparison between actual and estimated body mass index values (kg/ m) of hospitalized female adults.
SD = standard deviation; Actual BMI = actual weight / (actual height) ; BMI1 = actual weight /(A6)2; BMI2 =
actual weight /(A3)2; BMI3 = actual weight /(A4)2; BMI4 = P1/(actual height)2; BMI5 = P1/(A6)2; BMI6 = P1/(A3)2;
BMI7 = P1/(A4)2; BMI8 = P4/(actual height)2; BMI9 = P4/(A6)2; BMI10 = P4/(A3)2; BMI11 = P4/(A4)2; A3, A4 and P4 =
Rabito et al. (2006); A6 and P1 = Chumlea et al.7.
DISCUSSION
All estimated measures significantly differed from actual measures in
both sexes, except for height for men using the formula of Chumlea et al.7.
As in the present study, other authors1,8,18 also found no significant differ-
ences when comparing actual height measurements to those estimated by
Chumlea et al.7.
This formula has the advantage of easy application, as it requires the
measurement of a single measure, KH, requiring the use of one caliper.
One of the formulas of easy application and widely used in clinical
practice to estimate height is the formula that used twice the half-span
(A1)4. This measure showed the largest difference from the actual measured
in the present study. Other studies1,18 also found significant overestimation
of the actual height with this measure. Other studies found different re-
sults20-23, obtaining statistical similarity between actual height and twice
the half-spam. The formula developed by WHO5, which uses wingspan
also resulted in statistically significant differences in this study, but with
a smaller difference from the actual measurement. A similar result was
found by Beghetto et al.24, who obtained a significant difference between
actual measure and that estimated by WHO5, with a mean difference of
3 cm between them, which use was not recommended despite its easy
application.
Recumbent height (A5)13 also did not result in average height closer to
the actual measure, overestimating 3 cm in height for males and 4 cm for
females. A similar result was obtained by Rodrigues et al.20.
CONCLUSION
By comparing methodologies for estimating body weight and height
used in this study with actual measures, it was observed that these methods
showed a trend of overestimating body measures in both sexes. The only
estimated measures that showed no significant difference from the actual
measure was height for men, using anthropometric variable knee height.
This measure is of easy application in clinical practice.
With respect to the body weight estimation, no results showed signifi-
cant similarity. Whereas weight variation is a strong indicator to assess the
effectiveness of the therapeutic procedures, methodological alternatives for
obtaining this measure should be proposed.
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Given that BMI is the most widely used nutritional diagnosis method,
we sought to identify which combinations of estimated weight and height
would result in BMI more close to actual BMI. It was observed that the
use of body weight and height obtained from formulas developed by the
same author resulted in BMI more close to actual BMI.
There are still few national studies comparing different methodologies
for estimating body weight and height in adults and especially analyzing
the nutritional status of populations from these measures. Thus, further
research should be carried out in order to validate existing equations and
compare specific population groups using formulas that combine effective-
ness, low cost and easy application.
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E-mail: raquel@hu.ufsc.br
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